Smart Thinking blog

The fifth estate

How the media reports on the pharma industry

If you're like me, then you probably have a bunch of healthcare news feeds that automatically appear in your inbox every morning. At last count I had twenty-three. And every morning I scour these news feeds for important and interesting stories. Most of the articles or stories are 'run-of-the-mill' commercial or health policy updates. Once in a while, the same story is presented slightly differently in two separate news feeds. Quite often, I learn something new (retaining it is altogether another issue). And more and more often I see content that leaves me scratching my head. Scratching my head because I'm not sure how the conclusions were drawn from what was written or how the article itself made it past the editor's desk.

In the May 2016 issue of Report on Business which I found in the seat pocket of my Montreal-to-Toronto flight, I read an article entitled Rx for Excess (catchy title, eh?) in which the author's basic premise is that the public has been brainwashed into thinking that high drug prices are not only justified but also an inescapable and inevitable result of high R&D costs and that we've come to accept this flimsy defence. The author then attempts to point out some of the holes in this tried-and-true pharma defence model. Needless to say, my view is that the article misses many points that would have balanced the discussion (regardless of whether I agree with the conclusion) and I wrote a long email to the author and editor pointing this out, without response or acknowledgement.

Last week, Harvard's T.H. Chan School of Public Health and STAT published the results of a new poll aimed at understanding public opinion on certain provisions of the 21st Century Cures Act - specifically the goal of making drug and medical devices available faster. And to be clear, this was the title of the article: Public wary of faster approvals of new drugs, STAT-Harvard Poll finds. I suppose the headline is accurate. It's a shame that the question was so skewed that the headline didn't have an asterisk next to it. See Figure 1 for the original question and my proposed new question - which is a much clearer question and likely to provide a more accurate answer to the insight that is being sought. The only good thing about the STAT-Harvard poll is that it provides a statement in the methodology section which acknowledges that 'question wording may contribute to a possible source of error' within the study. Hallelujah. So I wrote to the project lead who happens to be the Professor of Health Policy and Public Health at Harvard and I got no response. So, I wrote to the authors of the article and pointed out my perspective. This time I got a response: “Many thanks”, they wrote back.

The fifth estate can be very influential in shaping public policy and general opinion across a variety of settings

These are just two examples from the last few days. There are dozens and dozens of others. This is becoming a real concern for me and, I presume, for others like me who spend a great deal of time writing and speaking about healthcare issues. We have always grappled with the 'shocking headlines designed to sell newspapers' society that we live in. Today it seems to be a 'shocking headlines designed to attract eyeballs so as to attract new sponsors and increase ad rates' society. No matter. Six of one and half a dozen of another. It's all the same. And let's be clear, it's not about whether these publications get back to me or not; it's a surrogate marker for how I presume they respond (or don't) to anyone who asks about their editorial process or their sources or potential bias in their work.

The fifth estate is a sociocultural reference to groupings of outlier viewpoints in contemporary society such as those associated with bloggers, journalists and non-mainstream media outlets. These 'outlier viewpoints' can be incredibly powerful as they build grassroots movements and help organise the public to take a stance on an issue. And the fifth estate can be very influential in shaping public policy and general opinion across a variety of settings (think of the rise of certain candidates or certain issues in political campaigns, social uprisings like the Arab Spring, or the inappropriate use of deadly force that police forces deal with all the time).

We can argue and dispute whether STAT and The Globe and Mail's Report on Business are truly 'outlier viewpoints' or mainstream media outlets. Nonetheless, when these viewpoints cross the imaginary line of credibility where the public can tell that the claims and assertions may border on the sensational, this important social thread fails and it fails badly. And when it fails badly, we lose a crucial voice in the healthcare debate.

Original question

Proposed 'new' question

It can take about ten years of development, testing and review before new prescription drugs meet government safety and effectiveness standards and are made available to the public. Some people want to change these government standards to make new drugs available faster. Others say that changing government standards to speed up the process would increase the risk that drugs with harmful side effects or ones that are less effective would be approved for public use. Do you favour or oppose changing government standards to make the process for developing new drugs faster?

It can take about ten years of development, testing and review before new prescription drugs meet government safety and effectiveness standards and are made available to the public. Some people want these government standards to remain the same - which could potentially prevent patients and doctors from having access to new, life-saving therapies that could improve quality of life and substantively reduce mortality. Others want to change the government standards to speed up the process - which could potentially increase the risk that drugs with harmful side effects or ones that are less effective would be approved for public use. Do you favour or oppose changing government standards to make the process for developing new drugs faster?